Abstract
BackgroundUse of selective serotonin reuptake inhibitors (SSRI) during pregnancy is common while the effect on the infant’s neurological outcome is unknown. Our objective was to determine the effects of prenatal SSRI-exposure on the infants’ neurological functioning, adjusted for maternal mental health.MethodsA prospective observational study from May 2007 to April 2010. The study groups comprised 63 SSRI-exposed infants (SSRI group) and 44 non-exposed infants (non-SSRI group). Maternal depression and anxiety were measured using questionnaires. The main outcome measures during the first week after birth and at three to four months were the quality of the infants’ general movements (GMs) according to Prechtl and a detailed motor optimality score. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for abnormal GM quality in the SSRI and non-SSRI groups, and adjusted for maternal depression, anxiety, and other confounders. The study was registered under 53506435 in the ISRCTN.FindingsAll infants were born around term. During the first week, abnormal GMs occurred more frequently in the SSRI group than in the non-SSRI group (59% versus 33%) and the median MOS was lower (13 versus 18). The OR for abnormal GMs in the SSRI versus the non-SSRI group was 3·0 (95% CI, 1.3 to 6.9) and increased after adjustment for confounders. At three to four months, more SSRI-exposed infants had monotonous movements (48% versus 20%) with lower median MOSs (26 versus 28). The OR for monotonous movements was 3·5 (95% CI, 1.5 to 8.6) and increased after adjusting for confounders.InterpretationPrenatal exposure to SSRI had an adverse effect on early neurological functioning as reflected by GM quality, irrespective of maternal depression and anxiety, and other confounders. Physicians should take this into account in consultation with parents.
Highlights
Women’s mental health problems during pregnancy are associated with adverse consequences for their infants, such as preterm birth, low birth weight, and may have long-term behavioural and developmental problems.[1,2,3] Since approximately 10% to 25% of pregnant women fulfil the diagnostic criteria for depression[1,4,5] and 7% to 18% those for anxiety disorder[6,7], neonatal consequences of maternal mental health problems may have major effects on child health and development
The Beck Depression Inventory (BDI) score during pregnancy correlated highly with the BDI score at the infants’ age of three to four months (Spearman’s rho = 0.62; p,.001); the same was true for the State Trait Anxiety Inventory (STAI)-S score (Spearman’s rho = 0.72; p,.001)
We demonstrated that prenatal selective serotonin reuptake inhibitors (SSRI) exposure has a negative effect on the quality of general movements (GMs) and as such it is a reflection of the negative effect these antidepressants have on early neurological outcome
Summary
Women’s mental health problems during pregnancy are associated with adverse consequences for their infants, such as preterm birth, low birth weight, and may have long-term behavioural and developmental problems.[1,2,3] Since approximately 10% to 25% of pregnant women fulfil the diagnostic criteria for depression[1,4,5] and 7% to 18% those for anxiety disorder[6,7], neonatal consequences of maternal mental health problems may have major effects on child health and development. Improved understanding of the influence of maternal depression on adverse outcome of pregnancies has resulted in prescription rates of antidepressant medication during pregnancy ranging from 2.0% in the Netherlands to 13.4% in the USA.[8,9] Of all the antidepressants, selective serotonin reuptake inhibitors (SSRIs) are used most frequently.[8,9] Since SSRIs readily cross the placenta [10] concern has risen about the short-term and longterm effects of prenatal exposure to SSRIs on the developing foetus.[4,11,12,13,14,15,16]. In the part of the study presented here, our aim was to determine the effects of prenatal SSRI exposure on early neurological functioning of the infant, adjusted for maternal mental health. Our objective was to determine the effects of prenatal SSRI-exposure on the infants’ neurological functioning, adjusted for maternal mental health
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